Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Phoenix Family Care on 14 November 2016. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Learning was shared with staff but outcomes had not always been actioned.
• Not all appropriate recruitment checks had been carried out on staff prior to being employed by the practice. Medical indemnity checks had not always been carried out on locum GPs employed and the physical and mental health of newly appointed staff had not been considered.
• Systems were in place to monitor patients who took high risk medicines.
• An overarching training matrix and policy was in place to monitor that all staff were up to date with their training needs and received regular appraisals.
• Patients often said they found it difficult to pre-book appointments although positive comments were made regarding the availability of urgent, same day appointments.
• Feedback from patients about their care was consistently positive and this was reflected in the national patient survey results, last published in July 2016.
• The practice had reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. For example, the practice offered extended opening hours on week day evenings and at weekends.
• The practice had good facilities and was well equipped to treat patients and meet their needs. However, the practice had not risk assessed the equipment and medication potentially required to respond to a medical emergency.
• The practice had an internal process to manage complaints. Although the process to receive and respond to complaints was effective, the practice had not made any significant improvements despite reoccurring, negative feedback about the appointment system.
• The practice had produced a practice development plan that documented the short-term priorities.
• The practice had visible clinical and managerial leadership but governance and audit arrangements were not always effective.

The areas where the provider must make improvement are:

• Ensure patients are protected against the risks of receiving unsafe care and treatment by:
• Ensuring learning outcomes from significant event reviews are implemented.
• Introduce a formal system to log, review, discuss and act on alerts received to minimise and mitigate risk to patient safety.
• Ensure medicines prescribed are in line with the guidelines for patients with epilepsy.
• Ensure there are sufficient arrangements in place to deal with a medical emergency.
• Implement effective systems to identify, assess and mitigate risks.
• Ensure that information is shared with the out of hours service for patients nearing the end of their life or if they had a ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) plan in place.
• Continuously review and adapt staffing levels and the skill mix to respond to the changing needs and circumstances of people using the service’
• Implement processes to demonstrate that the physical and mental health of newly appointed staff have been considered to ensure they are suitable to carry out the requirements of the role.
• Review the systems to ensure patients receive care in line with current evidence based guidance and standards.

The areas where the provider should make improvement are:

• Minimise the risk of accidental interruption to electricity supply to the medicines fridge in accordance with Public Health England guidance.
• Review the systems to improve the coordination of regular medication reviews.
• Carry out and assess regular fire evacuation drills.
• Consider the systems to ensure patient call/recall system to invite patients over 75 years of age for an annual health check.
• Fully complete patient care plans.
• Consider how to improve on the number of patient identified as having depression.
• Explore how the number of carers identified can be increased and consider what further support for carers could be provided from the practice.
• Consider implementing a bereavement policy or protocol.
• Take action to improve patient confidentiality at the reception desk and information in the patient waiting area.

Where, as in this instance, a provider is rated as inadequate for one of the five key questions or one of the six population groups it will be re-inspected no longer than six months after the initial rating is confirmed. If, after re-inspection, it has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place it into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Phoenix Family Care on 14 November 2016. As a result of our inspection the practice was rated as inadequate in safe, requires improvement in effective, responsive and well-led with good in caring; with an overall rating for the practice of requires improvement. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Phoenix Family Care on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 28 September and 10 October 2017, to confirm that the practice had carried out their plan to address the areas requiring improvement that we identified in our inspection in November 2016. This report covers our findings in relation to requirements and the improvements made since our last inspection.

We found the practice had carried out a detailed analysis of the previous inspection findings and taken action to address areas where improvements were needed. The practice had made extensive changes which had resulted in significant improvements. Practice staff had taken responsibility for embedding and maintaining these improvements and we saw a positive approach to performance and improvement throughout.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Learning was shared with staff and outcomes had been actioned.
• All appropriate recruitment checks had been carried out on staff prior to being employed by the practice. This included medical indemnity checks carried out on locum GPs employed, and the physical and mental health of newly appointed staff.
• Systems had been developed to monitor patients who took high risk medicines more effectively.
• An overarching training matrix and policy was in place to monitor that all staff were up to date with their training needs and received regular appraisals.
• Feedback from patients about their care was consistently positive and this was reflected in the National GP Patient Survey results published in July 2017.
• The practice had reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. For example, the practice offered extended opening hours on Monday and Wednesday between 6.30pm and 9.30pm and on Saturday and Sunday mornings.
• The practice had good facilities and was well equipped to treat patients and meet their needs. This included appropriate arrangements for equipment and medicine that may be required to respond to a medical emergency.
• The practice had an internal process to manage complaints.
• There was a practice development plan that documented both their long and short-term priorities. This included actions they had taken in response to patient feedback about the difficulty in accessing appointments, and the plans for continued improvements.
• The practice had visible clinical and managerial leadership with audit arrangements in place to monitor quality.

There were areas where the provider should make improvements:

• The provider should continue to recall patients with diabetes to ensure that all patients were monitored and kept under review.
• The practice should continue to work towards improving access and measure the impact of changes to improve it.

At our previous inspection on 14 November 2016, we rated the practice as requires improvement for providing responsive services. Although the practice had taken action to address areas for improvement it was too soon for the outcome of these actions to demonstrate impact, such as improvements to telephone access. The practice is still rated as requires improvement for providing responsive services.

The practice was rated as good in safe, effective, caring and well-led with requires improvement in responsive. The overall rating for the practice is now good.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice